Individual
MAMI NISHIWAKI MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1715 N GEORGE MASON DR, 403, ARLINGTON, VA 22205-3609
(703) 717-4300
(703) 717-4301
Mailing address
6035 BURKE CENTRE PKWY, 390, BURKE, VA 22015-3750
(703) 978-1196
(703) 978-7762
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
010130869
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710036611
874231
—
05
—
7399162
—
VA
Enumeration date
07/06/2006
Last updated
11/27/2023
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